Blood exposure - really worried

[DR79]

Hi doc...I wrote in a few weeks ago and you were able to reassure me...but I have something I'd like to add. My situation -

I had unprotected sex with a casual partner. I also performed unprotected oral sex on her. During the sex, I ejaculated inside her. When I pulled out, there was blood present (not a little, tiny bit of blood, but a good amount - it was all over my penis, legs, etc). Apparently, she had finished her period the day before (or so she thought).

We talked about our sexual histories, and she told me that she was in a monogamous relationship up until 7 months ago, and she had been tested 6 months ago - all negative. She had not been with anyone since her last test (6 months) except for me. I have no reason not to believe her...I'm trying to believe her for the sake of my own sanity.

At about 3 weeks past exposure, I have been experiencing diarrhea that has lasted for about a week, which is unusual for me. I have read that this can be a sign of initial infection and I'm freaking out. Would this type of diarrhea without any other symptoms be indicitive of ARS? I have an appt. for a rapid test on Thursday  - 30 days past exposure for a baseline result. If negative - is it safe to say that I'm most likely in the clear? Thanks for your help doc...your expertise can be quite reassuring.

[H. Hunter Handsfield, M.D.]

I recognize your username but don't recall anything about your previous thread.  But you can relax.  The reliability of HIV tests is not affected by EBV infection, and your results show you don't have HIV.  Your symptoms are entirely consistent with your acute EBV infection (i.e., infectious mononucleosis), which also affects CD4 and CD8 counts.  I'm sure your own provider has told you all this, and that person probably knows as much about these things as I do.

HHH, MD

[DrStupid]

Since it seems that Dr.H. is out this morning, I'll try to calm you down in the meantime.

1.  The chances you got HIV from this experience are astronomically low.  Almost certainly this woman is not HIVpoz, so the chance you got it are zero really, in my opinion, but see what Dr.H says.

2.  Diarhhea in itself is not a symptom of a recent HIV infection.  Actually, even in people who experience real ARS, diarhhea is not that common.

So relax and wait for your negative test results.

[DR79]

Dr. - I'm sorry but I think you may have posted a comment to another user's thread on my question?

[H. Hunter Handsfield, M.D.]

"I think you may have posted a comment to another user's thread on my question?"  I sure did.  Sorry!  That was part of my response for Mlk67, the thread before yours.

You describe a very low risk exposure.  I'll bet not one person a year catches HIV (in the US) from exposures of the sort you describe, especially given your partnter's testing history.  (Almost all heterosexually transmitted cases occur in the regular sex partners of people known to have HIV.)  As DrStupid already said, diarrhea is not an ARS symptom, especially when it is the only symptom.

I recommend against HIV testing in your situation; the risk simply isn't high enough.  However, all sexually active people (outside committed monogamous relationships) should have an HIV test from time to time, such as every 1-2 years.  If you haven't been tested recently, this would be a good time, since it's on your mind.  But this advice has nothing to do with the sexual exposure you describe.  (If you do it, just have a standard, laboratory-based test.  Rapid tests carry risk of false positive results.  Think what you'll go through for a few days if that happens, while you await the results of repeat testing.)

Good luck--  HHH, MD

[DR79]

Thank you for your timely response, Doctor. Someone should reserve a ocean-view suite for you in heaven!

My concern was that she wasn't being truthful with her past history - I have no reason to believe she's lying, but there are always the what-if's that pop up...especially with the emergence of the diarrhea @ 3 weeks.

My rapid test is scheduled at a clinic here in NY that uses the OraSure/OraQuick test - do those also have a high incidence of false positive?

[H. Hunter Handsfield, M.D.]

Most people don't lie outright, especially if the conversation didn't occur in the immediate heat of starting to have sex.  And HIV is rare in women in the US who are not commercial sex workers (and even in most of them) or injection drug users.  And the risk of transmission, if she did have HIV, averages only 1 chance per 2,000 episodes of sex.

All rapid tests have a higher rate of false positive results than laboratory-based antibody tests.  It's not a big chance, but it's still far more likely than the possibility that you caught HIV.

[DR79]

Last comment doc....even with the blood exposure and the diarrhea...the chances of me having contracted HIV are too low for you to consider it a high risk?

I'm sorrry...just want to make sure I understand everything.

[H. Hunter Handsfield, M.D.]

Oh come on. Do you really think I didn't take the entire scenario into account? Twice now I have said the diarrhea is irrelevant. Do you need to hear it a third time? The blood during sex also makes no signficant difference.

You came to this site for my expert advice and, one assumes, reassurance. You were given it. Now accept the good news and move on.

[Ton_e]

Let us know when you get your negative result...

[DR79]

I thought it was important to post and let the readers (and the doc) know that I tested via rapid test @ 4 weeks (30 days) and got a negative result. I know this is not conclusive (but 90% accurate, correct?) so It helped calm my anxieties a great deal.

Hope for all those worried out there....and further confirmation that the Doc knows what's up.

[ScaredinAbuDhabi]

DR79, I too had long term Diarhea (diarrhea) starting at week two and still have it on and off now at week 10.  I have tested negative three times with the latest being just today, week 10.  It is a concern but maybe if you hear that some one else here had a similar symptom and obviously does not have HIV it might help with anxiety.  I believe the Doc but plan to test at 13 weeks simply because the CDC indicates it.  We probably all will just for good measure and out of respect for the CDC, but trust the Doc, he truly is an expert and knows this subject matter.  Lastly, are you sure that when you performed oral you didn't "Rim" her?  If so, your Diarhea (diarrhea) could be caused by that.

[H. Hunter Handsfield, M.D.]

Please take any further discussion over to the HIV support forum.

Thanks--  HHH, MD